Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disorders and disturbances. This rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the doctors who treat patients may be the same people.
Competence in sleep medicine requires an understanding of a plethora of very diverse disorders, many of which present with similar symptoms such as excessive daytime sleepiness, which, in the absence of volitional sleep deprivation, "is almost inevitably caused by an identifiable and treatable sleep disorder," such as sleep apnea, narcolepsy, idiopathic central nervous system (CNS) hypersomnia, Kleine-Levin syndrome, menstrual-related hypersomnia, idiopathic recurrent stupor, or circadian rhythm disturbances. Another common complaint is insomnia, a set of symptoms that can have many causes, physical and mental. Management in the varying situations differs greatly and cannot be undertaken without a correct diagnosis.
Training and certification
The World Federation of Sleep Research & Sleep Medicine Societies (WFSRSMS) was founded in 1987. As its name implies, members are concerned with basic and clinical research as well as medicine. Member societies in the Americas are the American Academy of Sleep Medicine (AASM), the Sleep Research Society of the United States (SRS), the Canadian Sleep Society (CSS) and the Federation of Latin American Sleep Societies (FLASS). WFSRSMS publishes the Journal of Sleep Research, the Journal of Clinical Sleep Medicine, SLEEP and Sleep and Biological Rhythms and promotes both sleep research and physician training and education.
The Colleges of Medicine of South Africa (CMSA) provide the well-defined specialty Diploma in Sleep Medicine of the College of Neurologists of South Africa: DSM(SA), which was first promulgated by the Health Professions Council in 2007. The newly formed South African Society of Sleep Medicine (SASSM) was launched at its inaugural congress in February 2010. The society's membership is diverse; it includes general practitioners, ENT surgeons, pulmonologists, cardiologists, endocrinologists and psychiatrists.
WFSRSMS members in Asia include the Australasian Sleep Association (ASA) of New Zealand and Australia and the Asian Sleep Research Society (ASRS), an umbrella organization for the societies of several Asian nations.
The European Sleep Research Society (ESRS) is a member of the WFSRSMS. The Assembly of National Sleep Societies (ANSS), which includes both medical and scientific organizations from 26 countries as of 2007, is a formal body of the ESRS. The ESRS has published European Accreditation Guidelines for SMCs (Sleep Medicine Centres), the first of several proposed guidelines to coordinate and promote sleep science and medicine in Europe.
The American Academy of Sleep Medicine (AASM), founded in 1978, administered the certification process and sleep medicine examination for doctors until 1990. Its independent daughter entity the American Board of Sleep Medicine (ABSM) was incorporated in 1991 and took over the aforementioned responsibilities. As of 2007, the ABSM ceased administering its examination, as it conceded that an examination process recognized by the American Board of Medical Specialties (ABMS) was advantageous to the field. Candidates who passed the ABSM exam in 1978–2006 retain lifetime certification as Diplomates of that organization.
The American Board of Psychiatry and Neurology (ABPN), and the corresponding boards of Internal Medicine, of Pediatrics, and of Otolaryngology (ear, nose and throat, ENT) now administer collectively the Sleep Medicine Certification exam for their members. Each board supervises the required 12 months of formal training for its candidates, while the exam is administered to all of them at the same time in the same place. For the first five years, 2007–2011, during "grandfathering," there is a "practice pathway" for ABSM certified specialists. Additional, coordinated requirements are to be added after 2011. The ABPN provides information about the pathways, requirements and the exam on its website.
Sleep medicine is now a recognized subspecialty within anesthesiology, internal medicine, family medicine, pediatrics, otolaryngology, psychiatry and neurology in the US.
Pulmonologists, already subspecialists within internal medicine, may be accepted to sit for the board and be certified in Sleep Medicine after just a six-month fellowship, building on their knowledge of sleep-related breathing problems, rather than the usual twelve-month fellowship required of other specialists.
Sleep dentistry (bruxism, snoring and sleep apnea), while not recognized as one of the nine dental specialties, qualifies for board-certification by the American Board of Dental Sleep Medicine (ABDSM). The resulting Diplomate status is recognized by the AASM, and these dentists are organized in the Academy of Dental Sleep Medicine (USA).
Laboratories for sleep-related breathing disorders are accredited by the AASM, and are required to follow the Code of Medical Ethics of the American Medical Association. The new and very detailed Standards for Accreditation are available online. Sleep disorder centers, or clinics, are accredited by the same body, whether hospital-based, university-based or "freestanding"; they are required to provide testing and treatment for all sleep disorders and to have on staff a sleep specialist who has been certified by the American Board of Sleep Medicine and otherwise meet similar standards.
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